Prenatal Hand Expression of Breastmilk to Help Increase Breastfeeding Initiation and Exclusive Breastfeeding Rates

Background: The objective of this study is to assess whether antenatal hand expression at 39 gestational weeks helps increase patient confidence and skill with hand expression and increases initiation and exclusive breastfeeding rates. Methods: In this IRB-approved study, patients were consented at 34-39 weeks gestation and taught by an IBCLC to hand express, collect, and store colostrum and record output. Starting at 39 weeks gestation, participants were asked to practice hand expression 1-3 times/day until delivery. A postpartum survey assessed patient satisfaction with hand expression and opinions on breastfeeding self-efficacy. Chart review of postpartum or well-baby visit notes determined whether patients continued exclusively breastfeeding. Results: Of the 29 participants who delivered at Temple, 21/29 (72%) were exclusively breastfeeding on discharge, and only 11/29 (38%) reported exclusively breastfeeding at postpartum or well-baby visits. Barriers to the practice include maternal discomfort, low milk supply, and maternal and infant illness. Of the participants who completed the postpartum survey, 90% initiated breastfeeding and 72% reported hand expressing at home. They felt overall satisfied (8.1/10, ±1.62) with prenatal hand expression and stated that it was helpful in breastfeeding initiation (8.8/10, ±1.69). Conclusions: Prenatal hand expression starting as late as 39 gestational weeks still increased initiation and exclusive breastfeeding rates from 12% in the study period to 72% in the study group. Recognizing and addressing hand expression barriers during late pregnancy may help to further improve exclusive breastfeeding rates.